Chloroquine for prevention and treatment of malaria

(Date of issue: September 2014. Version: 2)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

What is it?

Chloroquine (Avloclor®, Malarivon®, Nivaquine®) is a medicine that is taken either on its own or in combination with other antimalarial medicines to:

• prevent malaria infection when travelling to certain parts of the world where malaria is common
• treat a person who has been infected with malaria 

Malaria is a serious illness that is spread by mosquito bites and can result in death. Malaria infection in pregnancy can be dangerous to the health of both mother and baby. Pregnant women are therefore advised to avoid travelling to areas where there is a risk of catching malaria. If you are pregnant or planning a pregnancy and cannot avoid travelling to a high risk malaria area ask your doctor for advice as soon as possible. You may need to start taking an antimalarial medicine a few weeks before you travel. Your doctor is the best person to help you decide what is right for you and your baby.

Is it safe to take chloroquine in pregnancy?

There is no evidence that chloroquine is harmful to an unborn baby, although more information about its use in pregnancy ideally needs to be collected. If you are travelling to certain regions you may be advised to take chloroquine. You should not avoid taking chloroquine because you are pregnant. The risk of harm to you and your baby from malaria is likely to be far greater than any potential risk from taking chloroquine. Chloroquine does not protect against malaria in all areas of the world and you should always ask your healthcare provider for up-to-date advice on the most appropriate antimalarial to suit your travel plans.

No antimalarial medicine is 100% effective and it is very important that you also reduce the chance of being bitten by using insect repellents, mosquito nets, and covering as much skin as possible with clothing, particularly between dawn and dusk. Please read our bumps leaflet on insect repellents for more information on which products are advised for use in pregnancy.

Can taking chloroquine in pregnancy cause a miscarriage?

There is currently no scientific evidence that using chloroquine in pregnancy will cause a miscarriage. Miscarriage rates have been investigated in six studies which analysed of a total of 5,000 women taking chloroquine. None of these studies found an increased risk of miscarriage with chloroquine use. Malaria infection during pregnancy has, however, been shown to increase the risk of miscarriage.

Can taking chloroquine in pregnancy cause my baby to be born with birth defects?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

There is no scientific evidence to suggest that women who take chloroquine in pregnancy are at increased risk of having a baby with a birth defect from any of the four studies that have investigated this. However, rates of birth defects have been studied in only around 600 babies of women who took chloroquine during the first three months of pregnancy and more research is therefore required.

Can taking chloroquine in pregnancy cause preterm birth?

Chloroquine use in pregnancy has not been shown to cause a baby to be born early in any of the four studies that have investigated this. Studies have, however, shown that preterm birth is more common in pregnant women with malaria infection. 

Can taking chloroquine in pregnancy cause my baby to be small at birth (low birth weight)?

Eleven studies have investigated whether chloroquine use in pregnancy may affect a baby’s weight at birth. Eight of these studies showed that women taking chloroquine were not at increased risk of having a low birth weight baby (<2500g), with some even showing that chloroquine treatment improved the chance of the baby not being too small at birth. The remaining three studies found that women taking chloroquine were more likely to have low birth weight babies than women taking other antimalarial medicines. However, in the areas where these studies were carried out, chloroquine may have been less effective at preventing malaria than the other medicines, meaning that more of the pregnant women taking chloroquine had malaria, which is known to be linked to having a low birth weight baby. It is therefore likely that the malaria infection (and not the chloroquine) was the reason these studies found that more babies weighed less than 2500g at birth.

Can taking chloroquine in pregnancy cause stillbirth?

No increased risk of stillbirth was seen in seven out of the eight studies of pregnant women taking chloroquine that have investigated this. Although one study showed that women taking chloroquine were more likely to have a stillbirth than women taking other antimalarials, this was thought to be due to chloroquine being less effective at preventing malaria than the other medicines, and so more women taking chloroquine had malaria during pregnancy, which is known to increase the risk of stillbirth.

Can taking chloroquine in pregnancy cause learning or behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour. 

A study of 251 one year old children who had been exposed to chloroquine in the womb showed that they were no more likely to have developmental problems than one year olds not exposed to chloroquine in the womb.

There is currently no known link between taking chloroquine in pregnancy and learning or behavioural problems such as attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder in the child, although to date no scientific studies have specifically investigated a link with these problems.

Because there are many aspects of learning and behaviour that have not yet been studied in relation to chloroquine exposure in the womb, much more research into this subject is required. It has been suggested that malaria infection during pregnancy might affect a baby’s developing brain, but this too needs to be confirmed in further studies.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

Taking chloroquine during pregnancy is not expected to cause any problems that would require extra monitoring of your baby. However, if you have been infected with malaria during your pregnancy your doctor may wish to monitor your pregnancy more closely.

Are there any risks to my baby if the father has taken chloroquine?

No studies have specifically investigated whether chloroquine used by the father can harm the baby through affects on the sperm, however most experts agree that this is very unlikely. More research on the effects of drug and medicine use in men around the time of conception is needed.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.  

General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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